Autism: Is a "Cure" Necessary?
According to the current edition of the Diagnostic and Statistical Manual, the disorder known as autism has three major groups of symptoms. The first group concerns social relationships; an autistic person may lack interest in social relations, or fail to pick up on nonverbal social cues. The second group encompasses language deficits; some autistic people never learn to speak at all, and those who do may have a limited vocabulary or only repeat what others have said. The final group of symptoms includes rigid routines and interests. One of the best-known symptoms of autism is a narrow or obsessive interest in a certain narrow field, such as trains or maps. In the same vein as these narrow interests, an autistic person may insist on an identical routine every day, or adhere to certain repetitive motions, such as hand-flapping or rocking in place (4).
Given that so many of the behaviors that autism affects, especially speech and perception, are associated with the nervous system, researchers have been working to understand the neurological bases of autism for years. Despite intensive research, however, no exact neurological or physiological cause or causes of autism have been precisely identified. Some researchers suggest that mirror neurons, which register associations between actions performed by the self and another person, are less active in autistic people, which may account for some of their difficulties with social interactions (2) Some suggest that mercury, both from the environment and from the preservative thimerosal, formerly used in the measles mumps rubella (MMR) vaccine, can serve as a catalyst for the disorder (9), although this theory is controversial and has been discredited in many larger-scale epidemiologal studies (7). But many people, noting the diverse array of symptoms that most autistic people present, do not believe that any one theory can explain the condition. Instead, they believe that a number of factors, working together in complex and unpredictable ways, bring about the condition; to try to find a single cause, they say, is a tough, if not altogether fruitless, goal (8).
Since the exact sources of autism are so elusive, physicians and therapists who work with autistic people cannot attack its neurological or physiological root causes directly. Instead, they often focus on changing the autistic person's behavior in childhood, encouraging actions like language use and eye contact and discouraging actions like self-injuring behavior which may affect quality of life later. The most common technique for changing these actions is Applied Behavior Analysis, or ABA. The specific behaviors targeted with ABA differ from child to child, but the basic principles and techniques are similar across cases. The technique, in its most basic form, involves reinforcement for acquisition of "normal" behaviors (such as grammatical speech or eye contact), lack of reinforcement for more "abnormal" or "stereotypically autistic" behaviors (such as repetitive motions or temper tantrums following a disruption of routine). Gradually, reinforcement for the positive behaviors is reduced, and eventually it stops entirely; at this point, it is hoped that the positive behaviors will carry over into other areas of the child's life, outside of therapy sessions (1).
Many autistic people, however, question both the effectiveness and the ethical integrity of ABA (6). One especially vocal opponent of the therapy is an autistic woman named Michelle Dawson. Consider the following claims from her 2004 piece "The Misbehaviour of Behaviourists" (3).
"No researcher can claim to know which behaviours are adaptive or maladaptive to that unknown central difference. No researcher knows or even has studied the extent to which ‘inappropriate' autistic behaviours are entangled with, and therefore contributors to, exceptional autistic abilities"
In other words, the traits that most people see as "problems" of autism may in fact be adaptive behaviors that help them to cope with symptoms such as sensory sensitivity. Autism, then, is simply a variant configuration of the brain's 10^12 neurons; it had advantages and disadvantages, like any other configuration, but is not inherently problematic. This view of autism is known as the neurodiversity model.
Temple Grandin is one famous autistic individual whose accomplishments support Dawson's ideas. Grandin has many of the sensory issues associated with autism; she describes her hearing as "a sound amplifier set on maximum loudness," (meaning that she has trouble tuning out background noises), and being hugged or touched as a child "sent an overwhelming tidal wave of stimulation through [her] body." These differences in feeling and perception suggest differences in sensory neuron sensitivity, an attentiveness to sensory input that most non-autistic people do not have. But Grandin's most remarkable accomplishments are a direct result of her visual, non-sequential thinking style, a style she claims is often characteristic of autism. She describes her thinking process as "playing different video tapes in a video cassette recorder in my imagination," and says that "thinking in language in words is alien to me." In Grandin's career as a "livestock equipment designer," this thinking style is incredibly beneficial. She can "visualize a video of the finished equipment in [her] imagination...run test systems in [her] head of how the systems would work with different size cattle...;"as a result, her designs for humane livestock-handling machines are world-renowed (5).
Cases like Temple Grandin lead me to question whether "curing" autism is a worthwhile approach to the condition. Rather than trying to combat every aspect of autism, to systematically drive it out of a person, I believe that therapists should concentrate only on symptoms that are physically harmful to the autistic person (e.g. head banging as a repetitive behavior), or those that directly threaten caretakers and others in daily contact with the person (e.g. extreme aggressiveness). Other symptoms, like limited language, sensory sensitivity, and narrow interests may certainly alter an autistic person's perceptions of the world, but they are not inherently harmful; some traits may even be beneficial, as in Temple Grandin's visual mind. Emily Dickinson once claimed "the brain is wider than the sky," meaning that the brain has a capacity to absorb both infinite physical ideas and concepts, "and you beside:" the so-called "I-function." But in this case, autism is wider than the brain; although the condition may stem in part from differences in neural wiring, its effects stem far beyond the brain itself. To cure a condition that affects both the physical body and the mental self so wholly would be to change their entire self, and their perceptions of the world.
1)Autism and Applied Behavioral Analysis
2)Understanding Emotions in Others: Mirror Neuron Dysfunction in Children with Autism Spectrum Disorders
3)The Misbehaviour of Behaviourists
4)DSM Definition of Autism
5)My Experiences with Visual Thinking Sensory Problems and Communication Difficulties, by Temple Grandin
6)How About Not Curing Us, Some Autistics are Pleading
7)A Population-Based Study of Measles, Mumps and Rubella Vaccination and Autism
8)The Causes of Autism Spectrum Disorders
9)An interview with Dr. Andrew Wakefield, proponent of autism-vaccine theory